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Resumen En los ultimos anos la inmunoterapia (particularmente los inhibidores de los puntos de control inmunitario) ha suscitado un gran interes en el tratamiento de los pacientes con cancer de pulmon, revolucionando el manejo de los pacientes con tumores localmente avanzados/metastasicos y generando esperanzas entre los pacientes y los medicos que diagnostican y tratan a estos enfermos. Estos farmacos se han convertido (combinados o no con otras terapias) en el tratamiento estandar de muchos pacientes con cancer de pulmon y se espera que su uso aumente significativamente en un futuro proximo. En este manuscrito revisaremos la importancia creciente de las tecnicas de imagen en la valoracion de respuesta al tratamiento con inmunoterapia de los pacientes con cancer de pulmon, haciendo hincapie en los nuevos criterios radiologicos especificos de respuesta con inmunoterapia, en las respuestas radiologicas atipicas (seudoprogresion, respuestas disociadas, hiperprogresion) y en las principales manifestaciones radiologicas de los eventos adversos asociados a la inmunoterapia (reacciones sarcoideas, toxicidades pulmonares, etc.). Los neumologos deben conocer no solo las respuestas radiologicas atipicas de la inmunoterapia y sus implicaciones pronosticas, sino tambien sus efectos secundarios y los nuevos criterios radiologicos de respuesta desarrollados para valorar la respuesta al tratamiento. En este trabajo se trataran conceptos claves como «seudoprogresion», «respuesta paradojica», «hiperprogresion» o «progresion no confirmada» y su significado en el manejo de los pacientes con cancer de pulmon tratados con inmunoterapia.

Pembrolizumab, a programmed death 1 inhibitor, has been shown to have clinically significant efficacy in different types of cancer, providing long-term survival benefit for patients with lung cancer. Herein, we report the development of a primary thyroid cancer in a lung cancer patient that was being treated with pembrolizumab. Primary thyroid malignancy (and not only metastatic disease or immunotherapy-induced thyroiditis) should be considered in patients with lung cancer being treated with immune checkpoint inhibitors who develop new incidental thyroid lesions on imaging studies.

BACKGROUND: Fibroblast growth factors (FGFs) have a fundamental role in cancer. Sequestering FGFs with GSK3052230 (FP-1039) blocks their ability to activate FGFRs while avoiding toxicities associated with small molecule inhibitors of FGFR, including hyperphosphatemia and retinal, nail, and skin toxicities. METHODS: A multicenter, open-label, phase Ib study evaluated weekly GSK3052230 added to pemetrexed/cisplatin in patients with treatment-naive, unresectable malignant pleural mesothelioma. Doses were escalated according to a 3 + 3 design, followed by cohort expansion at the maximum tolerated dose (MTD). Endpoints included safety, overall response rate, progression-free survival, and pharmacokinetics. RESULTS: 36 patients were dosed at 10, 15, and 20 mg/kg doses of GSK3052230. Three dose-limiting toxicities were observed at 20 mg/kg and one at 15 mg/kg. The MTD was defined as 15 mg/kg and used for cohort expansion. The most common treatment-related adverse events (AEs) were nausea (56%), decreased appetite (36%), infusion reactions (36%), decreased neutrophil counts (36%), and fatigue (33%). The confirmed ORR was 39% (95% CI: 23.1–56.5) (14/36 PRs) and 47% had stable disease (17/36), giving a disease control rate of 86%. At 15 mg/kg GSK3052230 (n = 25), the ORR was 44% (95% CI: 24.4–65.1), and the median PFS was 7.4 months (95% CI: 6.7–13.4). Four patients had disease control for over 1 year, and three were still ongoing. CONCLUSION: At 15 mg/kg weekly, GSK3052230 was well tolerated in combination with pemetrexed/cisplatin and durable responses were observed. Importantly, AEs associated with small molecule inhibitors of FGFR were not observed, as predicted by the unique mechanism of action of this drug.

Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as "pseudoprogresion", "paradoxical response", "hyperprogresion", or "unconfirmed progression", and their significance in the management of patients with lung cancer treated with immunotherapy.

The purpose of this article is to provide updated recommendations for the diagnosis and treatment of patients non-small-cell lung cancer (NSCLC). The staging system for lung cancer has recently been revised by the International Association for Study of Lung Cancer and patients with NSCLC shall now be staged according to the UICC system 7th edition. Recommendations for treatment were based on treatment strategies that improve overall survival. In functionally fit patients with stage I-II disease surgical resection is recommended. Four cycles of adjuvant cisplatin-based chemotherapy is recommended in patients with pathologic stage II-III. For patients with stage IIIA and non-bulky mediastinal lymph node survival was significantly improved with induction chemotherapy plus surgical resection. Patients with unresectable or bulky stage IIIA and those with stage IIIB, should be treated with platinum-based chemotherapy and thoracic radiotherapy. For patients with metastatic disease and performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For elderly patients and those with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with platinum-based chemotherapy, except for patients with certain clinical characteristics. Maintenance therapy with pemetrexed or erlotinib increases survival in patients who did not progress after 4 cycles of a platinum based chemotherapy. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs.

Las metastasis en la region selar e hipotalamica son raras y la principal manifestacion clinica es la diabetes insipida. Un hipopituitarismo concomitante se produce en muy pocas ocasiones. Presentamos el caso de un varon de 54 anos con carcinoma microcitico de pulmon e hipopituitarismo. Una resonancia magnetica cerebral revelo una lesion en la cara anterior del tercer ventriculo sin etiologia clara. El paciente inicio tratamiento con quimioterapia y la lesion desaparecio. Por lo tanto, el paciente fue diagnosticado de hipopitituarismo secundario a metastasis hipotalamica de carcinoma microcitico de pulmon.

Resumen Introduccion Los inhibidores del factor de crecimiento epidermico (EGFR) son unos nuevos agentes antineoplasicos en creciente desarrollo. Se utilizan fundamentalmente como tratamiento de segunda linea de tumores en estadios avanzados. La aparicion de una erupcion acneiforme facial en pacientes tratados con estos farmacos es frecuente y caracteristica. La literatura propone multiples opciones de tratamiento, tanto topico como sistemico. Hasta el momento, no hay una evidencia clara sobre ninguno de ellos. Pacientes y metodos Realizamos un estudio descriptivo de 6 pacientes que han sido tratados con doxiciclina en dosis de 100 mg diarios durante 3 semanas. Analizamos las caracteristicas clinicas de los pacientes y la eficacia del tratamiento. Resultados Cinco de los seis pacientes alcanzan la curacion total de la erupcion acneiforme con este tratamiento. Un paciente alcanza una respuesta parcial. Tras largos periodos de seguimiento, y a pesar de continuar el tratamiento con los inhibidores del EGFR, no se observa recaida. Conclusiones La doxicilina se plantea como un tratamiento eficaz en esta patologia. A pesar de ser una serie corta, los resultados en nuestros pacientes avalan dicha eficacia.

Pituitary metastases of solid tumours are infrequent, specially as a first manifestation. When they happen, they are usually due to breast or lung cancer and are asymptomatic or produce diabetes insipidus. It is very strange that they produce hormonal deficiency. We present a case report of a bronchogenic adenocarcinoma in a 65-year-old man which began with panhypopituitarism, diabetes insipidus and visual alterations. Magnetic resonance imaging revealed a large sellar mass, with clivus infiltration and invading the right cavernous sinus. The biopsy result was adenocarcinoma metastases from lung cancer.

Parasellar and hypothalamic metastases are uncommon. Their principal clinical manifestation is diabetes insipidus. Associated hypopituitarism is very rare. We report the case of a 54-year-old man with small cell lung cancer and hypopituitarism. A brain magnetic resonance imaging scan revealed a mass in the anterior region of the third ventricle with no clear etiology. The patient began chemotherapy treatment and the mass disappeared, which confirmed the diagnosis of secondary hypopituitarism caused by hypothalamic metastasis from small cell lung cancer.

Primary cardiac neoplasms are an infrequent disease, as most of the tumors arising in the heart are metastatic. Between the malignant tumors, sarcomas are the most frequent ones, accounting for at least 95% of them. We report the case of a 70-year old woman, diagnosed of primary cardiac osteosarcoma arising in the left atrium. Although complete excision of the tumor was performed, the disease relapsed and subsequently developed metastatic disease. In this paper, we also review briefly the management of this rare disease and the therapeutic options.

Epidermal growth factor inhibitors (EGFR) are new antineoplastic agents that are increasingly being developed. They are basically used as second line treatment in advanced stage tumors. Appearance of a facial acneiform rash in patients treated with these drugs is common and characteristic. The literature proposes multiple topical and systemic treatment options. Up to now, there is no clear evidence on any of them.A descriptive study of 6 patients who were treated with 100 mg daily dose of doxycycline for 3 weeks was conducted. Clinical characteristics of the patients and treatment efficacy were analyzed.Five of the six patients achieved total resolution of the acneiform rash with this treatment. One patient achieved partial response. After long follow-up periods and in spite of following treatment with the EGFR inhibitors, no relapse was observed.Doxycycline is suggested as an effective treatment in this disease. Even though it is a short series, the results in our patients support this efficacy.

Reportamos el caso de una mujer con un coriocarcinoma primario pulmonar. Su interes radica en la rareza del mismo, con menos de 30 casos publicados en la literatura, la mayoria en varones, asi como en el diagnostico diferencial planteado inicialmente con otros procesos trofoblasticos en mujeres. La evolucion de la enferma fue favorable para lo que cabria esperarse inicialmente, con una buena respuesta clinicopatologica a un regimen de quimioterapia intensivo-alternante, resaltando la importancia que el rescate quirurgico tuvo en la resolucion final del caso. En la discusion se abordan estos aspectos con mas profundidad, concluyendo la necesidad del abordaje multidisciplinar en estos pacientes.